| NPI | 1033196415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: VA 0101256478) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: GA 059399) |
| 207Y00000X Otolaryngology (Licence: NJ 25MA04977800) | |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2025-01-23 |