| NPI | 1871728014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WI 57308-20) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 036-130250) |
| Enumeration Date | 2009-05-18 |
| Last Update Date | 2012-08-15 |