| NPI | 1114989761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OH 35.096183) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MD D0063379) |
| 208200000X Plastic Surgery (Licence: MD D0063379) | |
| 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: MD D0063379) | |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2016-11-28 |