| NPI | 1770782443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: PR 18303) |
| Additional Taxonomies | 208600000X Surgery (Licence: PR 18303) |
| 208600000X Surgery (Licence: SC 34566) | |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2016-06-09 |