| NPI | 1316225113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD61161985) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036136120) |
| Enumeration Date | 2011-07-27 |
| Last Update Date | 2024-11-08 |