| NPI | 1689669970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: CO 27338) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CO 27338) |
| 207YX0602X Otolaryngology, Otolaryngic Allergy (Licence: CO 27338) | |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2008-12-31 |