| NPI | 1790758563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TX F0567) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: TX F0567) |
| 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: TX F0567) | |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2014-04-09 |