| NPI | 1942623566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NC 2022-01438) |
| Additional Taxonomies | 207YX0905X Otolaryngology Otolaryngology/Facial Plastic Surgery (Licence: NC 2022-01438) |
| Enumeration Date | 2014-02-03 |
| Last Update Date | 2025-08-14 |