| NPI | 1851954242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL 21531) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NJ 25MB12236700) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: FL 21531) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: FL 21531) | |
| 208D00000X General Practice (Licence: VA 0116034370) | |
| Enumeration Date | 2019-04-21 |
| Last Update Date | 2025-07-16 |