| NPI | 1144284670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NV 25350) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036-106258) |
| 208600000X Surgery (Licence: NY 238116-1) | |
| 208600000X Surgery (Licence: MI 4301033364) | |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2024-05-07 |