| NPI | 1417913302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NE 16395) |
| Additional Taxonomies | 2085R0001X Radiology, Radiation Oncology (Licence: NE 16395) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NE 16395) | |
| 207Y00000X Otolaryngology (Licence: NE 16395) | |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2013-12-13 |