| NPI | 1316207970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: CO DR.0066140) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA MT201628) |
| Enumeration Date | 2012-05-16 |
| Last Update Date | 2021-09-23 |