| NPI | 1316018815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MO 2011034568) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036101040) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2020-09-01 |