| NPI | 1982627196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MI 4301064416) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MI 2901014708) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2016-09-08 |