| NPI | 1164506267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036-137382) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN MD35876) |
| 208600000X Surgery (Licence: NC 2007-01555) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2022-10-20 |