| NPI | 1912937939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: KY 34451) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: KY 34451) |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: KY 34451) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2022-11-07 |