| NPI | 1760688428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: IL 036.142980) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301089792) |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2017-05-01 |