| NPI | 1700975372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CT 034947) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MA 150427) |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: CT 034947) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2021-05-13 |