| NPI | 1750709770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YS0123X Otolaryngology Facial Plastic Surgery (Licence: GA 84724) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: GA 7169) |
| 207YX0905X Otolaryngology Otolaryngology/Facial Plastic Surgery (Licence: AL 37848) | |
| Enumeration Date | 2014-04-07 |
| Last Update Date | 2020-07-23 |