| NPI | 1902896087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0102X Surgery Surgical Critical Care (Licence: MA 223980) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: MA 223980) |
| 208600000X Surgery (Licence: MA 223980) | |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2015-04-23 |