| NPI | 1770964488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL OS16438) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: PA OT016549) |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2023-08-25 |