| NPI | 1841458957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CT 51991) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 258854) |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: CT 51991) | |
| Enumeration Date | 2008-05-26 |
| Last Update Date | 2013-07-15 |