| NPI | 1801086368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: LA 026454) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: LA 026454) |
| 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: LA 026454) | |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2016-04-28 |