| NPI | 1598812216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: PA MD438633) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MT184085) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2016-04-25 |