| NPI | 1619325446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: PA MT211105) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036156986) |
| Enumeration Date | 2016-06-02 |
| Last Update Date | 2026-05-12 |