| NPI | 1790906006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 253091-1) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: NY 253091-1) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2010-06-25 |