| NPI | 1790911972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: GA 77567) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: GA 77567) |
| 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: GA 77567) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TN MD0000055433) | |
| 208200000X Plastic Surgery (Licence: TN MD0000055433) | |
| Enumeration Date | 2009-06-02 |
| Last Update Date | 2026-06-18 |