| NPI | 1053773879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2023027841) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036156562) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2023-11-28 |