| NPI | 1740202241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: TX 00497961) |
| Additional Taxonomies | 2086X0206X Surgery Surgical Oncology (Licence: TX 00497961) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2007-07-08 |