| NPI | 1306095708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MN 53297) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125054983) |
| 208600000X Surgery (Licence: MN 105060) | |
| Enumeration Date | 2008-09-10 |
| Last Update Date | 2010-09-16 |