| NPI | 1972747871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MN 59658) |
| Additional Taxonomies | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: MN 59658) |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: MN 59658) | |
| Enumeration Date | 2009-04-23 |
| Last Update Date | 2018-10-22 |