| NPI | 1255317483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: TX P2563) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CA AFE65816) |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2020-03-04 |