| NPI | 1831169135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IA 27987) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036088788) |
| 208600000X Surgery (Licence: MN 30957) | |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2021-04-27 |