| NPI | 1366612012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036-141917) |
| Additional Taxonomies | 208600000X Surgery (Licence: LA 026609) |
| 208600000X Surgery (Licence: WI 55772) | |
| Enumeration Date | 2008-03-10 |
| Last Update Date | 2021-03-01 |