| NPI | 1316142268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX P4790) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036126261) |
| 208600000X Surgery (Licence: FL ME98793) | |
| 208600000X Surgery (Licence: PA MD435582) | |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2022-01-12 |