| NPI | 1194915868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: OH 35095067) |
| Additional Taxonomies | 207YS0123X Otolaryngology Facial Plastic Surgery (Licence: CA A95823) |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2015-05-27 |