| NPI | 1003040882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PA MD454360) |
| Additional Taxonomies | 207YX0007X Otolaryngology Plastic Surgery within the Head & Neck (Licence: PA MD454360) |
| Enumeration Date | 2009-05-08 |
| Last Update Date | 2020-11-15 |