| NPI | 1619134145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX m9342) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 49854-020) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MI 4301093869) | |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2011-05-12 |