| NPI | 1598011397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: NV 20367) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CA A122105) |
| Enumeration Date | 2012-07-30 |
| Last Update Date | 2024-10-17 |