| NPI | 1265434823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: UT 163081-1205) |
| Additional Taxonomies | 208600000X Surgery (Licence: UT 163081-1205) |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2007-08-17 |