| NPI | 1720298060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX E7810) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TX E7810) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2011-10-31 |