| NPI | 1750404562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036116766) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA A99184) |
| Enumeration Date | 2007-04-08 |
| Last Update Date | 2022-07-28 |