| NPI | 1760577985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: VA 0101234835) |
| Additional Taxonomies | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: VA 0101234835) |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: VA 0101234835) | |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: VA 0101234835) | |
| 207YX0901X Otolaryngology, Otology & Neurotology (Licence: VA 0101234835) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2015-07-31 |