| NPI | 1013185842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D0099371) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 247251) |
| 208600000X Surgery (Licence: IL 036141318) | |
| Enumeration Date | 2008-02-14 |
| Last Update Date | 2024-01-19 |