| NPI | 1477509925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: AL 24251) |
| Additional Taxonomies | 208600000X Surgery (Licence: AL 24251) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2013-07-12 |