| NPI | 1386615672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NV 10393) |
| Additional Taxonomies | 207YX0905X Otolaryngology Otolaryngology/Facial Plastic Surgery (Licence: NV 10393) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2017-07-17 |