| NPI | 1003903832 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YS0012X (Licence: MI 5101012806) |
| Additional Taxonomies | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: MI 5101012806) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2021-03-09 |