| NPI | 1043453970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: FL ME106806) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IL 036122668) |
| 207ND0900X Dermatology, Dermatopathology (Licence: FL ME106806) | |
| 207ND0900X Dermatology, Dermatopathology (Licence: IL 036122668) | |
| Enumeration Date | 2009-04-08 |
| Last Update Date | 2010-12-16 |