| NPI | 1699739607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036169863) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101236379) |
| 208600000X Surgery (Licence: NC 2021-03370) | |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2025-10-20 |