| NPI | 1780066738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: IL 036.160543) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: IL 125.066594) |
| Enumeration Date | 2015-06-26 |
| Last Update Date | 2024-01-29 |