| NPI | 1477967404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX S5605) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125065469) |
| 208600000X Surgery (Licence: CO DR.0058405) | |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2021-06-30 |