| NPI | 1629133350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA G55292) |
| Additional Taxonomies | 1223P0106X Dentist Oral and Maxillofacial Pathology (Licence: CA 05) |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2007-09-28 |