| NPI | 1841452612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CA A163334) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: CT 61299) |
| 208200000X Plastic Surgery (Licence: CT 61299) | |
| 208200000X Plastic Surgery (Licence: CA A163334) | |
| Enumeration Date | 2008-07-01 |
| Last Update Date | 2024-04-29 |