| NPI | 1336156181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: VA 0101263795) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2000169652) |
| 208600000X Surgery (Licence: IL 036114896) | |
| 208600000X Surgery (Licence: WV 24649) | |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2022-07-13 |