| NPI | 1962761577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: IN 02006850A) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX 566595) |
| 208600000X Surgery (Licence: MI 5101026595) | |
| 208600000X Surgery (Licence: CT 66223) | |
| Enumeration Date | 2012-05-16 |
| Last Update Date | 2022-07-21 |