| NPI | 1619902582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PR 8708) |
| Additional Taxonomies | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: PR 8708) |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: PR 8708) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2010-11-17 |