| NPI | 1710913496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX N4071) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX N4071) |
| 208600000X Surgery (Licence: KY 39454) | |
| 208600000X Surgery (Licence: IN 11012818) | |
| 208600000X Surgery (Licence: PA MD072641) | |
| 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: TX N4071) | |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2010-03-18 |