| NPI | 1912032988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036104798) |
| Additional Taxonomies | 174400000X Specialist (Licence: IL 036104798) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2021-02-02 |