| NPI | 1518989862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: CA G28602) |
| Additional Taxonomies | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: CA G28602) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2010-10-11 |