| NPI | 1679656250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TX H4534) |
| Additional Taxonomies | 207YS0012X (Licence: TX H4534) |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: TX H4534) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2022-02-15 |