| NPI | 1063675825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MN 54249) |
| Additional Taxonomies | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: MN 54249) |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2020-11-10 |