| NPI | 1699972265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX v1193) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: GA 002402) |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2024-09-24 |