| NPI | 1013402874 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036173853) | 
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4351045078) | 
| 208600000X Surgery (Licence: AZ R77048) | |
| Enumeration Date | 2018-06-25 | 
| Last Update Date | 2025-08-31 |