| NPI | 1730319336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 193400000X Single Specialty (Licence: IL 036.141461) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301095093) |
| 208600000X Surgery (Licence: NC 2015-00961) | |
| Enumeration Date | 2009-07-17 |
| Last Update Date | 2016-09-01 |