| NPI | 1407278625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: MD D0033751) |
| Additional Taxonomies | 208600000X Surgery (Licence: IN 01027150A) |
| Enumeration Date | 2014-01-07 |
| Last Update Date | 2014-01-07 |