| NPI | 1508979139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: IA 38784) |
| Additional Taxonomies | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: KS 04-28457) |
| 208600000X Surgery (Licence: IA 38784) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2010-01-25 |