| NPI | 1528454881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: KY 58647) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TN MD0000062386) |
| 207Y00000X Otolaryngology (Licence: AR E-13111) | |
| 2086S0129X Surgery Vascular Surgery (Licence: TN MD0000062386) | |
| Enumeration Date | 2015-04-13 |
| Last Update Date | 2023-10-17 |