| NPI | 1568752004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: IL 036.140175) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WI 65913-20) |
| 207N00000X Dermatology (Licence: CA A154111) | |
| Enumeration Date | 2011-04-18 |
| Last Update Date | 2018-04-07 |