| NPI | 1770588873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: NC 2018-02557) |
| Additional Taxonomies | 174400000X Specialist (Licence: IL 036096047) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2020-10-01 |