| NPI | 1336133446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CT 036472) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: CT 007905) |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2011-11-01 |