| NPI | 1649313206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OK 31956) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MD 16007) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2016-03-09 |