| NPI | 1750790663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: AZ 75413) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: AZ 75413) |
| 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: AZ 75413) | |
| Enumeration Date | 2014-08-05 |
| Last Update Date | 2026-04-02 |