| NPI | 1952747628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A161492) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125-063161) |
| Enumeration Date | 2013-05-21 |
| Last Update Date | 2019-06-25 |