| NPI | 1861856379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 125.069022) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301504529) |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2023-12-12 |