| NPI | 1285923110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NY 287350) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: CA A140095) |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: NY 287350) | |
| Enumeration Date | 2011-03-31 |
| Last Update Date | 2019-02-05 |