| NPI | 1073844957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: TX P9864) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TX BP10034383) |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: AL 32968) | |
| Enumeration Date | 2010-01-16 |
| Last Update Date | 2024-09-26 |