| NPI | 1790911576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: HI MD-21894) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: TX R4944) |
| 207Y00000X Otolaryngology (Licence: WA MD 60443147) | |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: WA MD60443147) | |
| 208D00000X General Practice (Licence: NE 25871) | |
| Enumeration Date | 2009-06-07 |
| Last Update Date | 2021-09-20 |