| NPI | 1366676942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: CA 135518) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: AZ 43416) |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: NY 275033) | |
| Enumeration Date | 2009-05-11 |
| Last Update Date | 2023-04-26 |