| NPI | 1396300257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036.173534) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ 25MA12005600) |
| Enumeration Date | 2019-05-07 |
| Last Update Date | 2026-07-15 |