| NPI | 1285262253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA A202526) |
| Additional Taxonomies | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: NY 724578891) |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2025-07-01 |