| NPI | 1376878470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: CA 20A3830) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: CA 20A3830) |
| Enumeration Date | 2009-10-07 |
| Last Update Date | 2009-10-07 |