| NPI | 1194145334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 74985) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL C00001784349) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2014-04-25 |
| Last Update Date | 2021-09-22 |