| NPI | 1912973249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: TN 44489) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 31982) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2015-11-22 |