| NPI | 1164413704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 36775) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MA 36775) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2007-07-08 |