| NPI | 1669890554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: WA MD60668538) |
| Additional Taxonomies | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: CA A168101) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: CA A168101) | |
| Enumeration Date | 2014-03-29 |
| Last Update Date | 2026-06-15 |