| NPI | 1649237884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YX0905X Otolaryngology Otolaryngology/Facial Plastic Surgery (Licence: CA A82220) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 203671) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2012-09-17 |