| NPI | 1053354175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MA 77277) |
| Additional Taxonomies | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: MA 77277) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2023-03-30 |