| NPI | 1053622548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 54062) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036169150) |
| 208600000X Surgery (Licence: AZ R72245) | |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2024-04-05 |