| NPI | 1396817409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YS0123X Otolaryngology Facial Plastic Surgery (Licence: TX G4836) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX G4836) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2023-05-11 |