| NPI | 1932660065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: MO 2025034743) |
| Additional Taxonomies | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: MO 2025034743) |
| Enumeration Date | 2019-03-29 |
| Last Update Date | 2025-08-15 |