| NPI | 1568685626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NH 14479) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036-109347) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2011-07-18 |