| NPI | 1619966686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YS0123X Otolaryngology Facial Plastic Surgery (Licence: TX N3480) |
| Additional Taxonomies | 207YS0012X Otolaryngology Sleep Medicine (Licence: CA A95717) |
| 207YS0012X Otolaryngology Sleep Medicine (Licence: TX N3480) | |
| 207YS0123X Otolaryngology Facial Plastic Surgery (Licence: CA A95717) | |
| 207YX0905X Otolaryngology Otolaryngology/Facial Plastic Surgery (Licence: CO 39421) | |
| 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: TX N3480) | |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2020-02-19 |