| NPI | 1013404532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NC 2024-01326) |
| Additional Taxonomies | 207YX0007X Otolaryngology Plastic Surgery within the Head & Neck (Licence: PA MD474217) |
| Enumeration Date | 2018-04-19 |
| Last Update Date | 2024-10-09 |