| NPI | 1851779052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA 135974) |
| Additional Taxonomies | 2086S0120X Surgery, Pediatric Surgery (Licence: IL 036166547) |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2023-09-29 |