| NPI | 1417150913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YS0123X Otolaryngology Facial Plastic Surgery (Licence: CA A127025) |
| Additional Taxonomies | 207YS0123X Otolaryngology Facial Plastic Surgery (Licence: MI 4301090217) |
| 207Y00000X Otolaryngology (Licence: MI 4301090217) | |
| 207Y00000X Otolaryngology (Licence: CA A127025) | |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2024-04-29 |