| NPI | 1467431213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: IA 33897) |
| Additional Taxonomies | 174400000X Specialist (Licence: IA 33897) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: IA 33897) | |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2015-02-24 |