| NPI | 1518156611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: CA A78818) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CA A78818) |
| 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: CA A78818) | |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2022-06-01 |