| NPI | 1689829673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0129X (Licence: MI 4301092464) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301092464) |
| 2086S0129X (Licence: IN 01072882A) | |
| Enumeration Date | 2008-11-18 |
| Last Update Date | 2015-07-07 |