| NPI | 1629126651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036.125251) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A91251) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2025-07-08 |