| NPI | 1811489784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL ME159509) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NY 333683) |
| 207N00000X Dermatology (Licence: CT 70109) | |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2025-10-10 |