| NPI | 1710945886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YS0123X Otolaryngology Facial Plastic Surgery (Licence: TX J8037) |
| Additional Taxonomies | 207YX0602X Otolaryngology Otolaryngic Allergy (Licence: TX J8037) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2011-06-17 |