| NPI | 1265673396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036-047442) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2002010044) |
| 208600000X Surgery (Licence: KY 38270) | |
| 208600000X Surgery (Licence: CO 47178) | |
| Enumeration Date | 2009-03-19 |
| Last Update Date | 2009-03-19 |