| NPI | 1225395833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: TX R5912) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX R5912) |
| Enumeration Date | 2012-04-19 |
| Last Update Date | 2021-02-07 |