| NPI | 1821012980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NC 9800289) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: FL ME83568) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2022-09-21 |