| NPI | 1528556263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: NY 330135) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 330135) |
| Enumeration Date | 2018-04-27 |
| Last Update Date | 2025-02-03 |