| NPI | 1457328502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036109035) |
| Additional Taxonomies | 208600000X Surgery (Licence: IA 36204) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2024-09-25 |