| NPI | 1770522849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2005-01398) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NC 0090-00308) |
| 2082S0099X Plastic Surgery Plastic Surgery Within the Head and Neck (Licence: NC 2005-01398) | |
| 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: NC 2005-01398) | |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2010-07-28 |