| NPI | 1508880964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NH 5507) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: NH 5507) |
| 207YS0012X Otolaryngology, Sleep Medicine (Licence: NH 5507) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2008-05-08 |