| NPI | 1417393216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: SC 84779) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA MT204280) |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: FL ME139919) | |
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: FL ME139919) | |
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: OR MD187020) | |
| Enumeration Date | 2013-05-20 |
| Last Update Date | 2023-01-10 |