| NPI | 1457664047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WV 33334) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036.140609) |
| Enumeration Date | 2010-07-23 |
| Last Update Date | 2024-01-10 |