| NPI | 1619506573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NY 336513) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: NY 336513) |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2025-07-16 |