| NPI | 1063424331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OK 31852) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MA 256844) |
| 208200000X Plastic Surgery (Licence: MO R4P52) | |
| 208200000X Plastic Surgery (Licence: OH 35099577) | |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2019-12-18 |