| NPI | 1386624450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: TX J4545) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TX J4545) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2022-09-21 |