| NPI | 1578762027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MS 20023) |
| Additional Taxonomies | 2086S0105X Surgery Surgery of the Hand (Licence: MS 20023) |
| 2082S0099X Plastic Surgery Plastic Surgery Within the Head and Neck (Licence: MS 20023) | |
| Enumeration Date | 2007-07-15 |
| Last Update Date | 2009-08-05 |