| NPI | 1154718179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: CA A169007) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: UT 10092126-1205) |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2026-01-13 |