| NPI | 1700975620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NH 11716) |
| Additional Taxonomies | 207YX0007X Otolaryngology Plastic Surgery within the Head & Neck (Licence: NH 11716) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2011-06-08 |