| NPI | 1093196552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 75412) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125066911) |
| Enumeration Date | 2015-06-10 |
| Last Update Date | 2021-07-28 |