| NPI | 1780891176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: MI 4301088227) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301088227) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2012-08-16 |