| NPI | 1912469628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TX V1086) |
| Additional Taxonomies | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: TX V1086) |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2025-10-06 |