| NPI | 1043216112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery |
| Additional Taxonomies | 208200000X Plastic Surgery |
| 208600000X Surgery | |
| 2086S0120X Surgery Pediatric Surgery | |
| 2086S0127X Surgery Trauma Surgery | |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2007-12-17 |