| NPI | 1952442378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: PA md045430l) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: PA md045430l) |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: PA md045430l) | |
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: PA md045430l) | |
| 208200000X Plastic Surgery (Licence: PA md045430l) | |
| 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: PA md045430l) | |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2019-07-15 |