| NPI | 1134120934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: KY 21707) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: KY 21707) |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2010-10-08 |