| NPI | 1083909543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: FL OS20005) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 283673-1) |
| 208600000X Surgery (Licence: NY 283973-1) | |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2023-09-19 |