| NPI | 1508386459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: AL MD48347) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2017017580) |
| 208600000X Surgery (Licence: IN 01096133A) | |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2025-08-18 |