| NPI | 1629261383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX P3587) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MN 50155) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: OK 28975) | |
| Enumeration Date | 2007-08-24 |
| Last Update Date | 2016-11-17 |