| NPI | 1093166456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA OS021441) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036.156743) |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2026-03-02 |