| NPI | 1003015421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX P3310) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125-052980) |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2023-04-04 |