| NPI | 1023180700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YS0123X Otolaryngology Facial Plastic Surgery (Licence: KS 04-18081) |
| Additional Taxonomies | 207YS0123X Otolaryngology Facial Plastic Surgery (Licence: MO R9029) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2007-07-08 |