| NPI | 1508827353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NY 219208) |
| Additional Taxonomies | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: NY 219208) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2018-08-14 |