| NPI | 1811202948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MI 5101018723) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: MI 5101018723) |
| Enumeration Date | 2010-08-12 |
| Last Update Date | 2021-02-16 |