| NPI | 1861623704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX P7804) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX P7804) |
| Enumeration Date | 2009-07-27 |
| Last Update Date | 2018-12-27 |