| NPI | 1316980121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: RI 5879) |
| Additional Taxonomies | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: RI 5879) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2018-10-25 |