| NPI | 1316722275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NY 340006) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MN 34126) |
| Enumeration Date | 2023-08-29 |
| Last Update Date | 2025-09-22 |