| NPI | 1720085814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PA MD072771L) |
| Additional Taxonomies | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: PA MD072771L) |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2012-08-30 |