| NPI | 1871717140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: CA A112280) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MA 226240) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2013-08-07 |