| NPI | 1013161538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036133946) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 57015689) |
| Enumeration Date | 2008-11-11 |
| Last Update Date | 2021-10-20 |