| NPI | 1720428519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: ND 14958) |
| Additional Taxonomies | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: ND 14958) |
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: MN 63742) | |
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: PA OT015528) | |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2020-09-24 |