| NPI | 1962447326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: TX F3696) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: TX F3696) |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX F3696) | |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2019-04-01 |