| NPI | 1134336597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: NY 287411-1) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 287411-1) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2017-02-06 |