| NPI | 1629500087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0007X Otolaryngology Plastic Surgery within the Head & Neck (Licence: GA 95639) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: GA 95639) |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2023-07-18 |