| NPI | 1134416779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: IL 036.157030) |
| Additional Taxonomies | 208600000X Surgery (Licence: MS T-2469) |
| Enumeration Date | 2011-07-04 |
| Last Update Date | 2023-11-06 |