| NPI | 1164599825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: NC 02055) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: AL 25353) |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: FL ME103280) | |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2019-08-01 |