| NPI | 1659992360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: TN 77187) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OK 38157) |
| Enumeration Date | 2020-05-04 |
| Last Update Date | 2026-06-09 |