| NPI | 1306990114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: PA MD431397) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD431397) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2015-08-31 |