| NPI | 1184905697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: NY 268672) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 268672) |
| 207Y00000X Otolaryngology (Licence: VA 0101249529) | |
| Enumeration Date | 2011-08-30 |
| Last Update Date | 2016-06-16 |