| NPI | 1487690749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA G79290) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MN 45680) |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: MN 45680) | |
| 208600000X Surgery (Licence: MN 45860) | |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2019-05-13 |