| NPI | 1790913432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL MFC1800) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DTP520) |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2020-08-31 |