| NPI | 1346443967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX BP10041244) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MI 4301088748) |
| Enumeration Date | 2007-06-10 |
| Last Update Date | 2020-01-02 |