| NPI | 1114244084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: VA 0101271072) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: DC MD048906) |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: NY 261903) | |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: CA A135174) | |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: MD D0090838) | |
| Enumeration Date | 2010-04-30 |
| Last Update Date | 2021-07-05 |