| NPI | 1063858553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IA MD-46240) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036156827) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-05-11 |
| Last Update Date | 2021-12-14 |