| NPI | 1588676597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MS 15783) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MS 15783) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2007-08-06 |