| NPI | 1629210869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NM MD2012-0347) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036.121894) |
| Enumeration Date | 2009-04-02 |
| Last Update Date | 2024-12-30 |