| NPI | 1497915540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: TX p5276) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TX P5276) |
| 207Y00000X Otolaryngology (Licence: NY 275586) | |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2018-09-19 |