| NPI | 1265374466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA SPI957) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: CA SPI957) |
| Enumeration Date | 2026-04-07 |
| Last Update Date | 2026-04-20 |