| NPI | 1790786838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: MO R6g71) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MO R6G71) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2022-10-03 |