| NPI | 1518052430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2082S0099X Plastic Surgery Plastic Surgery Within the Head and Neck (Licence: FL ME50318) |
| Additional Taxonomies | 207YS0123X Otolaryngology Facial Plastic Surgery (Licence: FL ME50318) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2015-09-29 |