| NPI | 1942443312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: VA 0101260680) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MI 4301104429) |
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: TX Q5240) | |
| Enumeration Date | 2009-04-14 |
| Last Update Date | 2021-06-02 |