| NPI | 1164591970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: VA 0401410769) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: VA 0401410769) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2025-09-11 |