| NPI | 1497012488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: DC MD210001446) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125.062147) |
| Enumeration Date | 2012-04-16 |
| Last Update Date | 2022-06-03 |