| NPI | 1972589448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: LA MD205818) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: FL ME92995) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2016-10-04 |