| NPI | 1164619169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: MI 5101017526) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MT 18684) |
| Enumeration Date | 2007-10-03 |
| Last Update Date | 2024-04-23 |