| NPI | 1386654390 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WI 2024) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: IL 036096380) |
| 207N00000X Dermatology (Licence: IL 036096380) | |
| 207N00000X Dermatology (Licence: MI 4301093918) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: MI 4301093918) | |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2022-07-05 |