| NPI | 1063867356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: MI 5101026170) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: MI 5101022208) |
| Enumeration Date | 2016-04-25 |
| Last Update Date | 2021-06-08 |