| NPI | 1720912892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 125088177) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: 125.088177) |
| Enumeration Date | 2026-06-11 |
| Last Update Date | 2026-06-25 |