| NPI | 1538163993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: MI 4301036011) |
| Additional Taxonomies | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: MI 4301036011) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2008-07-08 |