| NPI | 1114948353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NM 2005-0527) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: AZ 36688) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2017-03-21 |