| NPI | 1649527193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: OH 57.000000) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX P1346) |
| Enumeration Date | 2012-08-14 |
| Last Update Date | 2017-08-04 |