| NPI | 1306037585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX N5616) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX N5616) |
| 207Q00000X Family Medicine (Licence: TX N5616) | |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2016-06-06 |