| NPI | 1326049453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CT 29149) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 196588) |
| 208200000X Plastic Surgery (Licence: CT 29149) | |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2022-02-05 |