| NPI | 1902123698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TX Q9096) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OK 8838) |
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: TX Q9096) | |
| 208200000X Plastic Surgery (Licence: TX Q9096) | |
| Enumeration Date | 2010-04-21 |
| Last Update Date | 2025-07-15 |