| NPI | 1780895755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: UT 374716-1205) |
| Additional Taxonomies | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: UT 374716-1205) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: UT 374716-1205) | |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2019-03-20 |