| NPI | 1548552094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: LA 311544) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA MD463204) |
| 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: LA 311544) | |
| Enumeration Date | 2011-05-03 |
| Last Update Date | 2019-09-23 |