| NPI | 1457573065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: LA MD.025571) |
| Additional Taxonomies | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: AL 28714) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2014-07-23 |