| NPI | 1962857128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: IA MD-52966) |
| Additional Taxonomies | 207YX0901X Otolaryngology Otology & Neurotology (Licence: IA MD-52966) |
| 207YX0905X Otolaryngology Otolaryngology/Facial Plastic Surgery (Licence: IA MD-52966) | |
| 207YP0228X Otolaryngology Pediatric Otolaryngology (Licence: IA MD-52966) | |
| 207Y00000X Otolaryngology (Licence: MO 2023014677) | |
| 207YX0007X Otolaryngology Plastic Surgery within the Head & Neck (Licence: IA MD-52966) | |
| Enumeration Date | 2016-04-25 |
| Last Update Date | 2024-08-08 |