| NPI | 1457710394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MO 2024024066) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NE 30264) |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: AZ 64141) | |
| Enumeration Date | 2016-02-21 |
| Last Update Date | 2024-08-12 |