| NPI | 1366447732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CT 042733) |
| Additional Taxonomies | 174400000X Specialist (Licence: CT 042733) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2014-08-29 |