| NPI | 1538423546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: SC 40788) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA MT201969) |
| 207Y00000X Otolaryngology (Licence: GA 080879) | |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: GA 080879) | |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: SC 40788) | |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2022-03-18 |