| NPI | 1255952354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OH 57.249098) |
| Additional Taxonomies | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: MN 78901) |
| Enumeration Date | 2020-04-29 |
| Last Update Date | 2025-03-14 |