| NPI | 1295806602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX D9408) |
| Additional Taxonomies | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: TX D9408) |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2022-07-25 |