| NPI | 1598743973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: UT 6004387-1204) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: NV 1143) |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2022-02-02 |