| NPI | 1194785014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD60021449) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036092891) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2011-06-13 |