| NPI | 1053432054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA a113977) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: CA a113977) |
| 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: CA a113977) | |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2013-04-23 |