| NPI | 1104934389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036117563) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD038860E) |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2015-10-02 |