| NPI | 1114121639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: LA MD.200218) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: GA 65500) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: LA 200218) | |
| 208200000X Plastic Surgery (Licence: FL ME147316) | |
| 208200000X Plastic Surgery (Licence: LA 200218) | |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2023-12-05 |