| NPI | 1760630685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A146651) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125051286) |
| 208600000X Surgery (Licence: FL ME116536) | |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2017-09-13 |