| NPI | 1568789279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0101276020) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: WI 71653-20) |
| 207N00000X Dermatology (Licence: IL 036.137205) | |
| 207N00000X Dermatology (Licence: SC 51923) | |
| Enumeration Date | 2010-04-21 |
| Last Update Date | 2022-08-11 |