| NPI | 1992723183 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: SC ME138195) | 
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: SC ME138195) | 
| 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: SC ME138195) | |
| Enumeration Date | 2006-07-17 | 
| Last Update Date | 2025-02-09 |