| NPI | 1205850518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: OH 030354) |
| Additional Taxonomies | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: OH 030354) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: OH 030354) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2007-07-09 |