| NPI | 1598147274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: OK 47740) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX T6911) |
| 208600000X Surgery (Licence: WY 14784A) | |
| 208600000X Surgery (Licence: GA 76746) | |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2026-05-14 |