| NPI | 1528046349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: VA 0101055871) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: VA 0101055871) |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2019-03-12 |