| NPI | 1104931286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: IL 036129960) |
| Additional Taxonomies | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: WA MD60024722) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2024-01-11 |