| NPI | 1881182962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: NY 320272) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: NY 320272-01) |
| Enumeration Date | 2018-04-25 |
| Last Update Date | 2024-12-03 |