| NPI | 1508031824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036139682) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD432412) |
| 208600000X Surgery (Licence: CA A115017) | |
| 208600000X Surgery (Licence: OH 35.093595) | |
| Enumeration Date | 2008-04-28 |
| Last Update Date | 2022-07-21 |