| NPI | 1053725077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2865M2000X Military Hospital, Military General Acute Care Hospital (Licence: IN 01075743a) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT206044) |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2019-05-24 |