| NPI | 1437538881 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: MA 288000)  | 
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MA 288000)  | 
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: NY 303409)  | |
| Enumeration Date | 2015-05-19 | 
| Last Update Date | 2023-04-26 |