| NPI | 1881147825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: PR 24394) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 328788) |
| Enumeration Date | 2016-07-26 |
| Last Update Date | 2025-07-29 |