| NPI | 1639189780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: KY 16490) |
| Additional Taxonomies | 208600000X Surgery (Licence: IN 01052529A) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2014-08-19 |