| NPI | 1962498055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0102X Surgery, Surgical Critical Care (Licence: IL 036-064734) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036-064734) |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2021-04-26 |