| NPI | 1710962238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: UT 7698810-1205) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.093357) |
| 208600000X Surgery (Licence: IL 036-114835) | |
| Enumeration Date | 2005-12-07 |
| Last Update Date | 2021-12-20 |