| NPI | 1174795744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: DE c20008811) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MI 5101017079) |
| 208D00000X General Practice (Licence: DE C20008811) | |
| 207Q00000X Family Medicine (Licence: DE C20008811) | |
| Enumeration Date | 2008-03-24 |
| Last Update Date | 2011-04-22 |