| NPI | 1881618429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: TX N9522) |
| Additional Taxonomies | 208600000X Surgery (Licence: MN 48579) |
| 208200000X Plastic Surgery (Licence: MN 48579) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2013-02-13 |