NPI | 1780112144 |
---|---|
Entity Type | Individual |
Gender | N/A |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MI 5101027472) |
Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: MI 5101023077) |
Enumeration Date | 2017-05-30 |
Last Update Date | 2023-07-24 |