| NPI | 1720230451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0007X Otolaryngology Plastic Surgery within the Head & Neck (Licence: CA A112446) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: AL MD 29049) |
| Enumeration Date | 2008-10-13 |
| Last Update Date | 2021-12-15 |