| NPI | 1316056245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX Q2768) |
| Additional Taxonomies | 208600000X Surgery (Licence: WA ML20008564) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: MA 246710) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2018-04-09 |