| NPI | 1114105095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IN 01071022A) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 094152) |
| 208600000X Surgery (Licence: PA MD429945) | |
| Enumeration Date | 2008-02-04 |
| Last Update Date | 2020-12-17 |