| NPI | 1861621633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036138487) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125.055834) |
| 208600000X Surgery (Licence: OH 35123279) | |
| Enumeration Date | 2009-07-14 |
| Last Update Date | 2015-09-17 |