| NPI | 1538262860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: IA MD-55731) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WA 35054) |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: IA MD-55731) | |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2025-09-09 |