| NPI | 1497722300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: CT 016246) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CT 016246) |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2013-08-09 |