| NPI | 1598770430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: FL 107122) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: OH 35088257) |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: FL 107122) | |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2010-06-24 |