| NPI | 1962476358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 202K00000X (Licence: TN 46227) |
| Additional Taxonomies | 208600000X Surgery (Licence: TN 46227) |
| 202K00000X (Licence: GA 061073) | |
| 208600000X Surgery (Licence: GA 061073) | |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2016-05-09 |