| NPI | 1093891400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: FL ME104923) |
| Additional Taxonomies | 208600000X Surgery (Licence: AL 3675849) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2019-03-06 |