| NPI | 1306817689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WV 22204) |
| Additional Taxonomies | 207YS0123X Otolaryngology Facial Plastic Surgery (Licence: NC 200200300) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2020-09-23 |