| NPI | 1720405004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NV 19869) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CA A157725) |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: CA A157725) | |
| Enumeration Date | 2014-03-25 |
| Last Update Date | 2020-11-30 |