| NPI | 1164976585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A149876) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036140611) |
| Enumeration Date | 2016-08-15 |
| Last Update Date | 2018-09-11 |