| NPI | 1992791495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA A97516) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OK 22219) |
| 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: OK 22219) | |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: OK 22219) | |
| 207YX0602X Otolaryngology, Otolaryngic Allergy (Licence: OK 22219) | |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2015-09-08 |