| NPI | 1790184513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: IL 036136678) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IL 036136678) |
| 207NS0135X Dermatology Procedural Dermatology (Licence: IL 036136678) | |
| Enumeration Date | 2014-08-18 |
| Last Update Date | 2015-03-05 |