| NPI | 1326012493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: PA B40951) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: OR MD161559) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2020-06-19 |