| NPI | 1770755308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: TX N3731) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: MD D67277) |
| Enumeration Date | 2008-03-24 |
| Last Update Date | 2010-01-04 |