| NPI | 1477523967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: WV 12657) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: VA 0101042197) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2015-01-08 |