| NPI | 1205989258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA A74511) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CA A74511) |
| Enumeration Date | 2007-01-20 |
| Last Update Date | 2016-09-28 |