| NPI | 1629364534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CO DR.0059462) |
| Additional Taxonomies | 208D00000X General Practice (Licence: IN 01072163A) |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2024-05-20 |