| NPI | 1861524407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: IL 036-059474) |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: IL 036-059474) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2008-11-19 |