| NPI | 1629166111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL 96256) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL dn16234) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2007-07-08 |