| NPI | 1942498357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: WA MD60527918) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: NM MD2009-0449) |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: NM MD2009-0449) | |
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: NM MD2009-0449) | |
| Enumeration Date | 2007-10-10 |
| Last Update Date | 2023-03-07 |