| NPI | 1174006571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A208347) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IL 125.079505) |
| 207R00000X Internal Medicine (Licence: IL 125.079505) | |
| Enumeration Date | 2018-09-11 |
| Last Update Date | 2026-08-24 |