| NPI | 1174623227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: IA MD-41973) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX BP20032170) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: PA MD449430) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2014-08-11 |