| NPI | 1790179604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036.157404) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL ME144221) |
| Enumeration Date | 2015-03-28 |
| Last Update Date | 2022-01-18 |