| NPI | 1831751437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: SC 82976) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: GA 90853) |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: GA 90853) | |
| 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: SC 82976) | |
| Enumeration Date | 2019-07-03 |
| Last Update Date | 2022-07-26 |