| NPI | 1982645461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: FL ME66793) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: FL ME66793) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2011-08-26 |