| NPI | 1750356234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: IL 36-103048) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NE 34882) |
| Enumeration Date | 2006-02-20 |
| Last Update Date | 2022-08-22 |