| NPI | 1063477974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MA 253255) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 278034) |
| 207Y00000X Otolaryngology (Licence: OH 35079500W) | |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2025-12-09 |