| NPI | 1578917936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA a185841) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036161333) |
| Enumeration Date | 2016-04-21 |
| Last Update Date | 2025-06-12 |