| NPI | 1538154703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: RI 7280) |
| Additional Taxonomies | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: RI 7280) |
| 2082S0099X Plastic Surgery Plastic Surgery Within the Head and Neck (Licence: RI 7280) | |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2009-07-16 |