| NPI | 1093100349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: UT 1018454-1205) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: UT 1018454-1205) |
| 207Y00000X Otolaryngology (Licence: UT 1018454-8905) | |
| Enumeration Date | 2015-04-03 |
| Last Update Date | 2021-11-10 |