| NPI | 1821441643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036.175054) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2023014174) |
| Enumeration Date | 2016-07-16 |
| Last Update Date | 2025-09-02 |