| NPI | 1982984977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IL 036129104) |
| Additional Taxonomies | 208600000X Surgery (Licence: IL 125058737) |
| Enumeration Date | 2011-08-22 |
| Last Update Date | 2016-01-21 |