| NPI | 1558637124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036150641) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 61656-20) |
| 208600000X Surgery (Licence: GA 080171) | |
| Enumeration Date | 2012-03-28 |
| Last Update Date | 2023-03-06 |