| NPI | 1699715441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036122525) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35085022) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2015-11-19 |