| NPI | 1154697274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WI 22686) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IL 036143292) |
| Enumeration Date | 2012-03-23 |
| Last Update Date | 2025-07-28 |