| NPI | 1396866273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NC 2012-00528) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2012-00528) |
| 208600000X Surgery (Licence: GA 000500) | |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2015-11-12 |