| NPI | 1477502474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: LA 019581) |
| Additional Taxonomies | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: LA 019581) |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: LA 019581) | |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2012-04-24 |