| NPI | 1023495520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 1019022) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 0361455820) |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2024-06-17 |