| NPI | 1760646129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA 60195226) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IL 125052525) |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2011-08-01 |