| NPI | 1710987755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: CT 039152) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CT 039152) |
| 2082S0099X Plastic Surgery Plastic Surgery Within the Head and Neck (Licence: CT 039152) | |
| 2082S0105X Plastic Surgery Surgery of the Hand (Licence: CT 039152) | |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2008-06-05 |