| NPI | 1538629746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: IL 125.075115) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: IL Pending) |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2019-06-19 |