| NPI | 1780977066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YS0123X Otolaryngology Facial Plastic Surgery (Licence: CA A127561) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CA A127561) |
| 207Y00000X Otolaryngology (Licence: VA 0101274538) | |
| 207YS0123X Otolaryngology Facial Plastic Surgery (Licence: VA 0101274538) | |
| Enumeration Date | 2011-05-19 |
| Last Update Date | 2023-09-26 |