| NPI | 1518329341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NC 2023-01463) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: NC 2023-01463) |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: CA A150450) | |
| 207Y00000X Otolaryngology (Licence: CA A150450) | |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2023-08-02 |