| NPI | 1760579718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA G88334) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CT 040296) |
| 207Y00000X Otolaryngology (Licence: NY 200165) | |
| 207YS0012X (Licence: CT 040296) | |
| 207YS0012X (Licence: NY 200165) | |
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: CA G88334) | |
| Enumeration Date | 2006-10-09 |
| Last Update Date | 2011-11-19 |