| NPI | 1013322080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2019014000) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 12506876) |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2019-06-27 |