| NPI | 1528556263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: NY 330135) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: FL 160545) |
| Enumeration Date | 2018-04-27 |
| Last Update Date | 2024-11-08 |