| NPI | 1508110198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036149330) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA 79450) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-11-04 |
| Last Update Date | 2021-12-28 |