| NPI | 1164314266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CA SPI897) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CA SPI897) |
| 207YS0012X Otolaryngology, Sleep Medicine (Licence: CA SPI897) | |
| Enumeration Date | 2025-07-15 |
| Last Update Date | 2025-08-26 |