| NPI | 1417103557 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: GA 072477)  | 
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: IL 125055289)  | 
| Enumeration Date | 2008-08-08 | 
| Last Update Date | 2018-09-05 |