| NPI | 1124063920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MS 10675) |
| Additional Taxonomies | 2082S0099X Plastic Surgery Plastic Surgery Within the Head and Neck (Licence: MS 10675) |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2007-07-08 |