| NPI | 1003085846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: WI 24820) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 24830) |
| Enumeration Date | 2008-02-26 |
| Last Update Date | 2015-03-19 |