| NPI | 1669737243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NV 20691) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125061318) |
| 208600000X Surgery (Licence: IL 036.138098) | |
| Enumeration Date | 2012-07-10 |
| Last Update Date | 2024-02-22 |