| NPI | 1063565075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: NM MD2012-0882) |
| Additional Taxonomies | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: WA MD00016472) |
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: SD 8123) | |
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: NM MD2012-0882) | |
| Enumeration Date | 2007-01-21 |
| Last Update Date | 2013-05-13 |