| NPI | 1013171214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036127368) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125049263) |
| Enumeration Date | 2008-07-16 |
| Last Update Date | 2022-02-03 |