| NPI | 1982825352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: OH 35088522) |
| Additional Taxonomies | 208600000X Surgery (Licence: OH 35.088522) |
| 2086S0102X Surgery, Surgical Critical Care (Licence: OH 35.088522) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2016-05-10 |