| NPI | 1881699270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: TX E2789) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX E2789) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2008-04-29 |