| NPI | 1902148265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2022-02284) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125.062990) |
| Enumeration Date | 2013-03-25 |
| Last Update Date | 2022-09-07 |