| NPI | 1336355957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A97112) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036129327) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2017-03-29 |