NPI | 1740394121 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207W00000X Ophthalmology (Licence: LA 05392R) |
Additional Taxonomies | 207Y00000X Otolaryngology (Licence: LA 05392R) |
2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: LA 05392R) | |
208600000X Surgery (Licence: LA 05392R) | |
Enumeration Date | 2006-08-19 |
Last Update Date | 2007-07-08 |