| NPI | 1801852678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NJ 25MA07958900) |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NJ 25MA07958900) |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2018-05-23 |