| NPI | 1588689475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CO DR.0064841) |
| Additional Taxonomies | 208600000X Surgery (Licence: IN 01072225A) |
| 208600000X Surgery (Licence: OH 35120519) | |
| 208600000X Surgery (Licence: NC 2021-01577) | |
| 208600000X Surgery (Licence: KY 43685) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2022-06-22 |