| NPI | 1043541154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 54369-020) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 336.084547) |
| Enumeration Date | 2010-01-29 |
| Last Update Date | 2021-12-16 |