| NPI | 1942450234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: OH 34-008812) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 34-008812) |
| Enumeration Date | 2008-09-24 |
| Last Update Date | 2021-04-09 |