| NPI | 1972543155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: PA MD425228) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: PA MD425228) |
| 207N00000X Dermatology (Licence: NJ 25MA10197000) | |
| 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: NJ 25MA10197000) | |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2021-02-12 |