NPI | 1376803627 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX G1856) |
Additional Taxonomies | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: TX G1856) |
Enumeration Date | 2012-05-21 |
Last Update Date | 2012-05-21 |