| NPI | 1386223295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 125.079635) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MD 5931) |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2022-06-08 |