| NPI | 1184971194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: CA A155356) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A155356) |
| Enumeration Date | 2012-08-08 |
| Last Update Date | 2025-03-12 |