| NPI | 1710392246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036156256) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 282996) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: MA 282996) | |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2022-05-27 |