| NPI | 1568632156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: IN 01059988A) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35-091646) |
| Enumeration Date | 2008-03-10 |
| Last Update Date | 2011-10-31 |