| NPI | 1578621256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: TX N0472) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: GA 039240) |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: KY C2017) | |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2023-10-27 |