| NPI | 1316975444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OH 35.123953) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NC 200600334) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2026-01-29 |