| NPI | 1255338174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: SD 4246) |
| Additional Taxonomies | 207YP0228X Otolaryngology Pediatric Otolaryngology (Licence: SD 4246) |
| 207YS0123X Otolaryngology Facial Plastic Surgery (Licence: SD 4246) | |
| 207YX0602X Otolaryngology Otolaryngic Allergy (Licence: SD 4246) | |
| 207YX0901X Otolaryngology Otology & Neurotology (Licence: SD 4246) | |
| 207YX0905X Otolaryngology Otolaryngology/Facial Plastic Surgery (Licence: SD 4246) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2014-06-11 |