| NPI | 1164678421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA C130958) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: AZ 57228) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: FL ME102291) | |
| 208200000X Plastic Surgery (Licence: FL 155349) | |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2026-01-28 |