| NPI | 1003080201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: LA MD.206101) |
| Additional Taxonomies | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: LA MD.206101) |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: AL MD.32411) | |
| 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: AL MD.32411) | |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2014-08-01 |