| NPI | 1487671939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: TX N7552) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX N7552) |
| 2082S0099X Plastic Surgery Plastic Surgery Within the Head and Neck (Licence: MO 106313) | |
| 2082S0099X Plastic Surgery Plastic Surgery Within the Head and Neck (Licence: TX N7552) | |
| 2086S0120X Surgery Pediatric Surgery (Licence: MO 106313) | |
| 2086S0120X Surgery Pediatric Surgery (Licence: TX N7552) | |
| 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: MO 106313) | |
| 2086S0127X Surgery Trauma Surgery (Licence: MO 106313) | |
| 2086S0127X Surgery Trauma Surgery (Licence: TX N7552) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2011-01-28 |