| NPI | 1265635866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: LA MD.205962) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: LA MD.205962) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX M7367) | |
| Enumeration Date | 2007-06-09 |
| Last Update Date | 2017-05-09 |