| NPI | 1265478457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: TN 52085) |
| Additional Taxonomies | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: TX M2633) |
| 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: CA A108641) | |
| 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: VA 0101247646) | |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2017-02-01 |