| NPI | 1629399217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 35134333) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125.058352) |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2018-08-07 |