| NPI | 1457527509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other Surgical Assistant (Licence: IL 238.000284) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101245602) |
| Enumeration Date | 2008-05-07 |
| Last Update Date | 2011-08-29 |