| NPI | 1356684112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL ME156871) |
| Additional Taxonomies | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: FL ME156871) |
| 208200000X Plastic Surgery (Licence: CT 1.065132) | |
| Enumeration Date | 2013-03-30 |
| Last Update Date | 2026-06-18 |