| NPI | 1902162258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 54773) |
| Additional Taxonomies | 208600000X Surgery (Licence: NE 31181) |
| 208600000X Surgery (Licence: IN 01074174A) | |
| Enumeration Date | 2012-04-11 |
| Last Update Date | 2021-08-19 |