| NPI | 1780759381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MA 56708) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: RI 7012) |
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: MA 56708) | |
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: RI 7012) | |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2016-03-28 |