| NPI | 1376501940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 196361) |
| Additional Taxonomies | 208600000X Surgery (Licence: IN 1060363A) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2018-09-11 |