| NPI | 1710197413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: TX N2729) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: LA 026489) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2025-10-10 |