| NPI | 1104200575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA A137644) |
| Additional Taxonomies | 207YX0007X Otolaryngology Plastic Surgery within the Head & Neck (Licence: CA A137644) |
| 282N00000X General Acute Care Hospital | |
| Enumeration Date | 2015-07-16 |
| Last Update Date | 2015-07-30 |