| NPI | 1710949953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MI 43010143498) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MI 4301043498) |
| 208200000X Plastic Surgery (Licence: FL ME58533) | |
| 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: MI 4301043498) | |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2009-12-17 |