| NPI | 1679573034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: IN 01076415A) |
| Additional Taxonomies | 208600000X Surgery (Licence: NC 200501327) |
| 208600000X Surgery (Licence: KS 32580) | |
| 208600000X Surgery (Licence: OH 35083403) | |
| 208600000X Surgery (Licence: MD D73747) | |
| 208600000X Surgery (Licence: NM MD2020-0191) | |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2023-06-13 |