| NPI | 1801259098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 312841) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NY 312841-01) |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2026-08-20 |