| NPI | 1801869722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: NC 9500576) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NC 9500576) |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: NC 9500576) | |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2008-02-28 |