| NPI | 1366569121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA G88980) |
| Additional Taxonomies | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: RI RI07729) |
| Enumeration Date | 2007-03-24 |
| Last Update Date | 2020-03-19 |