| NPI | 1255452124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036150787) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 254927) |
| 208600000X Surgery (Licence: MI 5101015634) | |
| 208600000X Surgery (Licence: OH 34.011232) | |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2019-11-15 |