| NPI | 1255414272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: TX J4330) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX J4330) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2012-01-11 |