| NPI | 1083735401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: FL OS10621) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MI 5101016166) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2013-01-24 |