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 |