| NPI | 1033235635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MI 4301079458) |
| Additional Taxonomies | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: MI 4301079458) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2023-10-10 |