| NPI | 1407110430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME151150) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: SC LL34972) |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2021-06-28 |