| NPI | 1972778843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: CA 134756) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: MA 242360) |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2015-07-02 |