| NPI | 1770476798 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208800000X Urology (Licence: IL 125.086545) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2025-05-29 |
| Last Update Date | 2025-06-30 |