| NPI | 1275857542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: GA 67525) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CA A108630) |
| Enumeration Date | 2010-03-16 |
| Last Update Date | 2021-02-16 |