| NPI | 1417099359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: AZ 28911) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: AZ 28911) |
| 2082S0099X Plastic Surgery Plastic Surgery Within the Head and Neck (Licence: AZ 28911) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2019-08-29 |