| NPI | 1679921381 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207N00000X Dermatology (Licence: WI 3873-320) | 
| Additional Taxonomies | 207N00000X Dermatology (Licence: IL 036.153199) | 
| Enumeration Date | 2016-06-03 | 
| Last Update Date | 2024-11-05 |