| NPI | 1134315930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA a93834) |
| Additional Taxonomies | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: CA a93834) |
| 208600000X Surgery (Licence: CA a93834) | |
| Enumeration Date | 2007-09-14 |
| Last Update Date | 2020-04-28 |