| NPI | 1205034105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036.143945) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4313090728) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2022-07-21 |