| NPI | 1255478541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: ME 017897) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IL 036.126410) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2015-04-06 |