| NPI | 1770112872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036176421) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 69672) |
| 208600000X Surgery (Licence: MN 30731) | |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2025-08-19 |