| NPI | 1790878866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: NJ 25MA08549700) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY MD244214) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2021-05-19 |