| NPI | 1376650218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NM MD2012-0844) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: ND 14022) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: ND 14022) | |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2019-05-21 |