| 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 |