| NPI | 1063688117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101253581) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036-119783) |
| 208600000X Surgery (Licence: NC 2014-01211) | |
| 208600000X Surgery (Licence: TX N0215) | |
| Enumeration Date | 2008-05-07 |
| Last Update Date | 2020-11-20 |