| NPI | 1639531189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: RI MD19445) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MA 1016165) |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: RI MD19445) | |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2023-08-24 |