| NPI | 1629015888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NY 208819) |
| Additional Taxonomies | 208200000X Plastic Surgery (Licence: NY 208819) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2009-01-09 |