| NPI | 1316144223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0007X Otolaryngology Plastic Surgery within the Head & Neck (Licence: MO 2012011802) |
| Additional Taxonomies | 207YX0905X Otolaryngology Otolaryngology/Facial Plastic Surgery (Licence: MI 5101017309) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2021-08-11 |