| NPI | 1780997197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: IL 036059978) |
| Additional Taxonomies | 174400000X Specialist (Licence: IL 036059978) |
| Enumeration Date | 2010-07-15 |
| Last Update Date | 2010-07-15 |