| NPI | 1134175276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: TX N2128) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 228031) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2017-04-11 |