| NPI | 1215192745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: MI 4301106347) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 4301106347) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 2901019512) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MI 4301106347) | |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2020-09-08 |