| NPI | 1770688723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: NY 158614-1) |
| Additional Taxonomies | 207YS0123X Otolaryngology Facial Plastic Surgery (Licence: NJ 25MA04455400) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2008-11-19 |