| NPI | 1316176159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CO DR.0067992) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MA 278199) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: CA A170353) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MA 278199) | |
| Enumeration Date | 2009-07-14 |
| Last Update Date | 2022-03-24 |