| NPI | 1063942803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A194967) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125.071272) |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2025-09-23 |