| NPI | 1558822833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301515371) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125.077926) |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2026-08-20 |