| NPI | 1841560745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: TX S9535) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TX S9535) |
| Enumeration Date | 2012-01-09 |
| Last Update Date | 2024-09-19 |