| NPI | 1255599494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: NY 251462-1) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WA MD60003283) |
| Enumeration Date | 2008-05-23 |
| Last Update Date | 2009-08-10 |