| NPI | 1235450958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA A119742) |
| Additional Taxonomies | 207YX0007X Otolaryngology Plastic Surgery within the Head & Neck (Licence: MA 262971) |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2025-06-03 |