| NPI | 1912916263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA G70528) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IL 036-085852) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2022-10-12 |