| NPI | 1336101054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MA 160725) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: DC MD6119) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2026-08-25 |