| NPI | 1104269000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MI 4301515313) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IL 036.147026) |
| 207N00000X Dermatology (Licence: MN 62134) | |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2026-02-18 |