| NPI | 1609843697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: VA 0101226095) |
| Additional Taxonomies | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: VA 0101226095) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2009-02-25 |