| NPI | 1134278047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NM MD2016-0792) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036080224) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2016-12-01 |