| NPI | 1104187525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: VA 0101264569) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MA 252502) |
| Enumeration Date | 2012-06-01 |
| Last Update Date | 2024-03-11 |