| NPI | 1134426539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036.126086) |
| Additional Taxonomies | 208600000X Surgery (Licence: VT 042.0012418) |
| Enumeration Date | 2011-02-21 |
| Last Update Date | 2026-01-22 |