| NPI | 1649790627 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207N00000X Dermatology (Licence: IL 036.155306) | 
| Additional Taxonomies | 207N00000X Dermatology (Licence: GA 101902) | 
| Enumeration Date | 2017-06-21 | 
| Last Update Date | 2024-09-26 |