| NPI | 1174732200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: PA MD440916) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA MD440916) |
| 207Y00000X Otolaryngology (Licence: NJ 25MA09190600) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2023-03-22 |