| NPI | 1467587089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX R2779) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: TX 25726) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2022-05-24 |