| NPI | 1639332752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: VA 0101253696) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: VA 0101253696) |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2013-08-02 |