| NPI | 1285683326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 37779) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036145819) |
| 208600000X Surgery (Licence: WY 11528C) | |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2019-03-21 |