| NPI | 1235267519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX p1169) |
| Additional Taxonomies | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: TX p1169) |
| 2082S0105X Plastic Surgery, Surgery of the Hand (Licence: TX p1169) | |
| 208600000X Surgery (Licence: NC 121464) | |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2016-10-06 |