| NPI | 1902253636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: GA 92349) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TN 62626) |
| Enumeration Date | 2016-05-23 |
| Last Update Date | 2025-06-16 |