| NPI | 1356595268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YS0123X Otolaryngology Facial Plastic Surgery (Licence: FL ME96274) |
| Additional Taxonomies | 207YS0123X Otolaryngology Facial Plastic Surgery (Licence: LA 025413) |
| Enumeration Date | 2008-11-05 |
| Last Update Date | 2018-05-07 |