| NPI | 1003867854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: IA MD-50740) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: IA MD-50740) |
| 208200000X Plastic Surgery (Licence: IA MD-50740) | |
| 2082S0099X Plastic Surgery Plastic Surgery Within the Head and Neck (Licence: IA MD-50740) | |
| 2082S0105X Plastic Surgery Surgery of the Hand (Licence: KS MD-50740) | |
| 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: WI 45961) | |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2022-12-23 |