| NPI | 1609567288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036166163) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IL 036.166163) |
| Enumeration Date | 2023-05-16 |
| Last Update Date | 2023-11-30 |