| NPI | 1770718314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036130707) |
| Additional Taxonomies | 208600000X Surgery (Licence: CT 53296) |
| 208600000X Surgery (Licence: IL 125-055868) | |
| Enumeration Date | 2009-05-27 |
| Last Update Date | 2021-06-30 |