| NPI | 1356390207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: IA 36823) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036111419) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2021-04-27 |