| NPI | 1932161577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MA 205428) |
| 207YS0123X Otolaryngology Facial Plastic Surgery (Licence: MA 205428) | |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2018-11-05 |