| NPI | 1720315666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A115663) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036123187) |
| 2086S0127X Surgery, Trauma Surgery (Licence: IL 036123187) | |
| Enumeration Date | 2009-11-13 |
| Last Update Date | 2021-12-01 |