| NPI | 1639444086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: SC 86563) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MO 2018020349) |
| Enumeration Date | 2012-03-19 |
| Last Update Date | 2024-06-17 |