| NPI | 1215128996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NC 2025-02580) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TN MD0000043316) |
| 207Y00000X Otolaryngology (Licence: OH 35.093875) | |
| Enumeration Date | 2007-08-07 |
| Last Update Date | 2026-03-26 |