| NPI | 1720252661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: IN 01077797A) |
| Additional Taxonomies | 208600000X Surgery (Licence: VA 0101266925) |
| 208600000X Surgery (Licence: ME MD21742) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2022-11-29 |