| NPI | 1285908509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TN 64361) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: TN 64361) |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: TN Pending) | |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: TN 64361) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: IA T1125) | |
| Enumeration Date | 2012-03-05 |
| Last Update Date | 2025-01-10 |