| NPI | 1962664763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA MD60578003) |
| Additional Taxonomies | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: NY 269779) |
| 207Y00000X Otolaryngology (Licence: NY 269779) | |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2019-04-04 |