| NPI | 1508858432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NE 24521) |
| Additional Taxonomies | 2086S0127X Surgery, Trauma Surgery (Licence: IA 36164) |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2011-12-01 |