| NPI | 1083691216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TX E8296) |
| Additional Taxonomies | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: TX E8296) |
| 207YS0012X Otolaryngology, Sleep Medicine (Licence: TX E8296) | |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: TX E8296) | |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: TX E8296) | |
| 207YX0602X Otolaryngology, Otolaryngic Allergy (Licence: TX E8296) | |
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: TX E8296) | |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2009-07-30 |