| NPI | 1013948694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OH 35.125222) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TN 46380) |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: WV 22299) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2021-01-21 |