| NPI | 1669784658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IN 02004013A) |
| Additional Taxonomies | 208600000X Surgery (Licence: CO DR.0060504) |
| 208600000X Surgery (Licence: WA OP60861245) | |
| Enumeration Date | 2010-07-08 |
| Last Update Date | 2018-11-12 |