| NPI | 1669440376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: WI 41384) |
| Additional Taxonomies | 208600000X Surgery (Licence: WI 41384-020) |
| 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: MN 103704) | |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2015-05-15 |