| NPI | 1427103647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: HI 5596) |
| Additional Taxonomies | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: HI 5596) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2025-09-11 |