| NPI | 1376762799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: SC TL33030) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35085259) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2010-07-29 |