| NPI | 1609168327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: VA 0101259733) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: VA 0101259733) |
| Enumeration Date | 2011-05-12 |
| Last Update Date | 2024-09-03 |