| NPI | 1558312074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CT 040693) |
| Additional Taxonomies | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: CT 040693) |
| 207YX0602X Otolaryngology, Otolaryngic Allergy (Licence: CT 040693) | |
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: CT 040693) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2018-02-22 |