| NPI | 1285965905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036.133344) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 54098-21) |
| Enumeration Date | 2010-01-20 |
| Last Update Date | 2013-06-24 |