| 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 | 2026-05-18 |