| NPI | 1407172075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA A117677) |
| Additional Taxonomies | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: CA A117677) |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: CA A117677) | |
| Enumeration Date | 2010-04-07 |
| Last Update Date | 2017-05-11 |