| NPI | 1215105804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2082S0099X Plastic Surgery Plastic Surgery Within the Head and Neck (Licence: UT 83185641205) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: UT 83185641205) |
| Enumeration Date | 2008-02-15 |
| Last Update Date | 2012-08-07 |