| NPI | 1255312401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: HI DOS1441) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101013860) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2024-11-19 |