| NPI | 1639516313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: IL 036.142867) |
| Additional Taxonomies | 207NS0135X Dermatology, Procedural Dermatology (Licence: IL 036.142867) |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2023-01-03 |