| NPI | 1720263775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX P7016) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2019025576) |
| 208600000X Surgery (Licence: IL 036135141) | |
| Enumeration Date | 2008-01-08 |
| Last Update Date | 2021-06-23 |