| NPI | 1871904698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YX0905X Otolaryngology Otolaryngology/Facial Plastic Surgery (Licence: ID O-1265) |
| Additional Taxonomies | 207YS0123X Otolaryngology Facial Plastic Surgery (Licence: MI 5101021036) |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2019-08-07 |