| NPI | 1033307111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: GA 62082) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 57.005372) |
| Enumeration Date | 2007-10-14 |
| Last Update Date | 2022-06-03 |