| NPI | 1932197852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CT 043483) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: NY 236302) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2022-07-21 |