| NPI | 1124044789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PA MD-039732-E) |
| Additional Taxonomies | 207YS0123X Otolaryngology Facial Plastic Surgery (Licence: PA MD-039732-E) |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2014-10-23 |