| NPI | 1447817861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: CA 20A22276) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CA 20A22276) |
| Enumeration Date | 2019-05-21 |
| Last Update Date | 2025-10-12 |