| NPI | 1881981371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CT 55851) |
| Additional Taxonomies | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: CT 55851) |
| Enumeration Date | 2011-07-05 |
| Last Update Date | 2016-10-25 |