| NPI | 1245327246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: FL ME96799) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: GA 68723) |
| 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: GA 68723) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2023-03-07 |