| NPI | 1245612589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OR DO197280) |
| Additional Taxonomies | 207YX0602X Otolaryngology, Otolaryngic Allergy (Licence: OR DO197280) |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: OR DO197280) | |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: MI 5101021665) | |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2020-05-05 |