| NPI | 1710206131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036-141196) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125-057715) |
| Enumeration Date | 2010-05-25 |
| Last Update Date | 2025-05-08 |