| NPI | 1265475222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LA0401X Anesthesiology Addiction Medicine (Licence: FL ME108997) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: ND 9626) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2012-10-15 |