| NPI | 1659306348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: TX M0454) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: TX M0454) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2020-09-15 |