| NPI | 1205800596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KY 24465) |
| Additional Taxonomies | 208600000X Surgery (Licence: IN 01053054A) |
| 208600000X Surgery (Licence: VA 0101253264) | |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2020-02-12 |