| NPI | 1902960172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: KS 04-33336) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: KS 9405983) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2020-05-20 |