| NPI | 1639487499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OK 5285) |
| Additional Taxonomies | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: PA 0S014660) |
| Enumeration Date | 2010-09-15 |
| Last Update Date | 2021-04-13 |