| NPI | 1982887220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: TX p0896) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: CA a93200) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX P0896) | |
| Enumeration Date | 2007-12-10 |
| Last Update Date | 2015-04-20 |