| NPI | 1942277298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MO 2009005090) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: KS 04-33714) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2009-06-30 |