| NPI | 1003103698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: DC MD045982) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IL 125063983) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: DC MD045982) | |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2018-12-07 |