| NPI | 1396905444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: UT 6168743-1205) |
| Additional Taxonomies | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: AZ 18971) |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2020-08-27 |