| NPI | 1487619607 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: AZ 22172)  | 
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: AZ 22172)  | 
| 207YX0602X Otolaryngology, Otolaryngic Allergy (Licence: AZ 22172)  | |
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: AZ 22172)  | |
| 207YX0901X Otolaryngology, Otology & Neurotology (Licence: AZ 22172)  | |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: AZ 22172)  | |
| 207YS0012X Otolaryngology, Sleep Medicine (Licence: AZ 22172)  | |
| 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: AZ 22172)  | |
| Enumeration Date | 2006-04-19 | 
| Last Update Date | 2011-07-20 |