| NPI | 1760632384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036124623) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 36-3196629) |
| 208600000X Surgery (Licence: IA 40391) | |
| Enumeration Date | 2008-09-19 |
| Last Update Date | 2022-01-04 |