| NPI | 1902817323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PA MD422897) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: VA 0101239822) |
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: PA MD422897) | |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2014-07-31 |