| NPI | 1770735151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 062725) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036.122004) |
| Enumeration Date | 2008-10-16 |
| Last Update Date | 2014-07-07 |