| NPI | 1629504402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TX T3774) |
| Additional Taxonomies | 207YX0007X Otolaryngology Plastic Surgery within the Head & Neck (Licence: TX T3774) |
| 207YX0905X Otolaryngology Otolaryngology/Facial Plastic Surgery (Licence: TX T3774) | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2022-07-08 |