| NPI | 1306895610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NE 18651) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NE 18651) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NE 18651) | |
| Enumeration Date | 2006-05-06 |
| Last Update Date | 2011-06-29 |