NPI | 1902096928 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207N00000X Dermatology (Licence: IL 036.142442) |
Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: IL 036.142442) |
207NS0135X Dermatology, Procedural Dermatology (Licence: IL 036.142442) | |
Enumeration Date | 2007-07-26 |
Last Update Date | 2018-07-12 |