| NPI | 1124093307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D78323) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101249486) |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: IL 036135071) | |
| 208600000X Surgery (Licence: IL 036135072) | |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2022-12-06 |