| NPI | 1053468876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KY 3354) |
| Additional Taxonomies | 208600000X Surgery (Licence: KY TP700) |
| 208600000X Surgery (Licence: IN 02003834A) | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2019-05-03 |