| NPI | 1700853066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: VA 0101043485) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: VA 0101043485) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2020-03-10 |