| NPI | 1467448563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036110944) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME99233) |
| 208600000X Surgery (Licence: NY 274794) | |
| 208600000X Surgery (Licence: IN 01060655A) | |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2014-09-11 |