| NPI | 1376713826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036120235) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME 97576) |
| Enumeration Date | 2008-03-11 |
| Last Update Date | 2024-03-21 |