| NPI | 1407067705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MS 24236) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: SC 32525) |
| 208600000X Surgery (Licence: OH 57007052) | |
| 208600000X Surgery (Licence: SC 32525) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: SC 32525) | |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2016-10-04 |