| NPI | 1417174608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OR MD216630) |
| Additional Taxonomies | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: CO 0056618) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2023-07-28 |