| NPI | 1548465834 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: AR E6045) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: CA A95600) |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: AZ 37260) | |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2013-03-12 |