| NPI | 1982646782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: NY 239725) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: NH 15491) |
| 207N00000X Dermatology (Licence: PA MD431602) | |
| 207N00000X Dermatology (Licence: NY 239725) | |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2018-03-13 |