| NPI | 1740654110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: IL 125074787) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125074787) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-11-21 |
| Last Update Date | 2020-06-03 |