| NPI | 1821355793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD61031228) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR 173106) |
| 208600000X Surgery (Licence: IL 036146622) | |
| Enumeration Date | 2012-04-17 |
| Last Update Date | 2020-08-25 |