| NPI | 1215913264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CO 43223) |
| Additional Taxonomies | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: CO 43223) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2013-12-19 |