| NPI | 1093146763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301111518) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125060385) |
| Enumeration Date | 2013-12-06 |
| Last Update Date | 2020-01-07 |