| NPI | 1205181351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: GA 80762) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: GA 80762) |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2023-03-16 |