| NPI | 1285861120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: IA MD-50117) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD450954) |
| 208600000X Surgery (Licence: TN MD0000056454) | |
| 208600000X Surgery (Licence: MI 4301094689) | |
| 208600000X Surgery (Licence: MI 5315041522) | |
| 208600000X Surgery (Licence: HI MD18168) | |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2022-09-30 |