| NPI | 1649460163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: UT 10361256-1204) |
| Additional Taxonomies | 207YX0905X Otolaryngology Otolaryngology/Facial Plastic Surgery (Licence: MI 5101015940) |
| 207YX0905X Otolaryngology Otolaryngology/Facial Plastic Surgery (Licence: WA OP 60077459) | |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2023-06-29 |