| NPI | 1225098882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: PA MD034789E) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA MD034789E) |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2012-09-24 |