| NPI | 1518145622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD00049446) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036117493) |
| Enumeration Date | 2008-01-31 |
| Last Update Date | 2012-02-03 |