| NPI | 1417283094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: GA 14225) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: GA 14225) |
| Enumeration Date | 2009-11-02 |
| Last Update Date | 2009-11-02 |