| NPI | 1033591565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036.153027) |
| Additional Taxonomies | 208600000X Surgery (Licence: ND RL13724) |
| Enumeration Date | 2015-06-20 |
| Last Update Date | 2020-09-14 |