| NPI | 1811177652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: NC 2008-01743) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NC 2008-01743) |
| Enumeration Date | 2007-11-09 |
| Last Update Date | 2019-10-23 |