| NPI | 1083111645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WI 104102) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: SC 91595) |
| 207Y00000X Otolaryngology (Licence: NY 327014) | |
| 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: SC 91595) | |
| Enumeration Date | 2018-04-10 |
| Last Update Date | 2026-09-30 |