| NPI | 1629279047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: VA 0101245920) |
| Additional Taxonomies | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: VA 0101245920) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2013-01-29 |