| NPI | 1497799613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036136219) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: NE 470) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2022-03-30 |