| NPI | 1376546101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX K2452) |
| Additional Taxonomies | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: TX k2452) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2018-07-26 |