| NPI | 1518007624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME101441) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 336-071255) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2011-12-01 |