| NPI | 1831359801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WI 63081) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA 112649) |
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: WI 63081) | |
| Enumeration Date | 2008-06-13 |
| Last Update Date | 2022-06-30 |