| NPI | 1376508150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 208600000X Surgery (Licence: MA 37975) |
| Additional Taxonomies | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: MA 37975) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2007-07-08 |