| NPI | 1093821274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX G7634) |
| Additional Taxonomies | 2082S0105X Plastic Surgery, Surgery of the Hand (Licence: TX G7634) |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: TX G7634) | |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2017-02-06 |