| NPI | 1376564021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MS 13503) |
| Additional Taxonomies | 2082S0099X Plastic Surgery Plastic Surgery Within the Head and Neck (Licence: MS 13503) |
| 2082S0105X Plastic Surgery Surgery of the Hand (Licence: MS 13503) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2020-10-21 |