| NPI | 1477642619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MI 4301042729) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: MI 4301042729) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2012-04-04 |