| NPI | 1861706855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 007813) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036-137628) |
| 208600000X Surgery (Licence: MI 5101018578) | |
| Enumeration Date | 2010-08-02 |
| Last Update Date | 2020-03-04 |