| NPI | 1760497226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: MA 154977) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NM 2005-0084) |
| 207Y00000X Otolaryngology (Licence: MA 154977) | |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: MA 154977) | |
| 207YX0602X Otolaryngology, Otolaryngic Allergy (Licence: NM md2005-0084) | |
| 208200000X Plastic Surgery (Licence: MA 154977) | |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2009-09-23 |