| NPI | 1831184779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NY 186813) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: NY 186813) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NY 186813) | |
| Enumeration Date | 2005-09-16 |
| Last Update Date | 2016-07-28 |