| NPI | 1558333179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: UT 10222796-1205) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MN 47669) |
| 207Y00000X Otolaryngology (Licence: IA 39672) | |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: IA 39672) | |
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: IA 39672) | |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2017-04-11 |