| NPI | 1104041326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: CO DR.0053492) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MN 49658) |
| 207Y00000X Otolaryngology (Licence: FL ME103522) | |
| 207Y00000X Otolaryngology (Licence: WA MD60286714) | |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: WA MD60286714) | |
| Enumeration Date | 2007-04-14 |
| Last Update Date | 2014-12-04 |