| NPI | 1861791386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036-169489) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 64498) |
| 208600000X Surgery (Licence: MI 4301111469) | |
| Enumeration Date | 2011-03-23 |
| Last Update Date | 2024-05-24 |