| NPI | 1912169053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX BP20019087) |
| Additional Taxonomies | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: MN 104625) |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2013-08-12 |