| NPI | 1417159625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: CO 48708) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ 76938) |
| 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: MN 103757) | |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2012-08-24 |