| NPI | 1730508052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: IL 036153116) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.133719) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2020-10-07 |