| NPI | 1396744652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: VA 0101273372) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WV 19053) |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: VA 0101273372) | |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2021-11-30 |