| NPI | 1316121205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: TX M7789) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX M7789) |
| 208600000X Surgery (Licence: TX M7789) | |
| Enumeration Date | 2007-12-27 |
| Last Update Date | 2016-05-12 |