| NPI | 1003813379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: GA 038416) |
| Additional Taxonomies | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: GA 038416) |
| 207YS0012X (Licence: GA 038416) | |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2017-01-10 |