| NPI | 1245433614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NY 274610) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: WA 60346313) |
| 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: NY 274610) | |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2016-01-05 |