| NPI | 1194720201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: TX L8996) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: MO 2006001525) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2008-04-22 |