| NPI | 1578682993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: IL 036.137286) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ 37371) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2022-07-24 |