| NPI | 1225476609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NC 2019-02065) |
| Additional Taxonomies | 207YS0123X Otolaryngology Facial Plastic Surgery (Licence: NC 2019-02065) |
| Enumeration Date | 2013-06-07 |
| Last Update Date | 2020-03-06 |