| NPI | 1821390717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: PA MD438042) |
| Additional Taxonomies | 208600000X Surgery (Licence: PA MD438042) |
| Enumeration Date | 2010-11-26 |
| Last Update Date | 2016-04-28 |