| NPI | 1023218351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: SC 29995) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC 29995) |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2019-02-22 |