| NPI | 1750557047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: IL 036168582) |
| Additional Taxonomies | 2085R0001X (Licence: OH 57.013354) |
| 208600000X Surgery (Licence: OH 57.013354) | |
| Enumeration Date | 2008-05-06 |
| Last Update Date | 2024-04-23 |