| NPI | 1427101443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: CA G47175) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CA G47175) |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: CA G47175) | |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: CA G47175) | |
| Enumeration Date | 2007-01-21 |
| Last Update Date | 2016-04-28 |