| NPI | 1184640450 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MA 227818) | 
| Additional Taxonomies | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: MA 227818) | 
| Enumeration Date | 2006-07-13 | 
| Last Update Date | 2024-04-17 |