| NPI | 1316917057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: SC 33079) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: MN 32375) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2016-10-06 |