| NPI | 1336220268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: VA 0101252121) |
| Additional Taxonomies | 174400000X Specialist (Licence: SC LL27060) |
| 208200000X Plastic Surgery (Licence: VA 0101252121) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2012-10-03 |