| NPI | 1386640266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207PE0005X Emergency Medicine, Undersea and Hyperbaric Medicine (Licence: VA 0101032447) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: VA 0101032447) |
| 208600000X Surgery (Licence: VA 0101032447) | |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2008-03-11 |