| NPI | 1376503391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NE 27722) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NE 27722) |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: NE 27722) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2023-10-10 |