| NPI | 1780097105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 11744110-1205) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IL 036.145756) |
| Enumeration Date | 2014-06-03 |
| Last Update Date | 2021-08-26 |