| NPI | 1023396520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PA MD472150) |
| Additional Taxonomies | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: PA MD472150) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: MO 2011009936) | |
| Enumeration Date | 2011-08-01 |
| Last Update Date | 2020-10-14 |