| NPI | 1285718866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: SC 28156) |
| Additional Taxonomies | 208600000X Surgery (Licence: SC LL28156) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2019-03-11 |