| NPI | 1568967206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: FL ME165435) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: GA 93802) |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2024-10-03 |