| NPI | 1740589274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 265705) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: NY 265705) |
| Enumeration Date | 2011-03-23 |
| Last Update Date | 2023-11-29 |