| NPI | 1366949091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207YP0228X Otolaryngology, Pediatric Otolaryngology (Licence: CA A202425) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA MD475150) |
| Enumeration Date | 2018-04-09 |
| Last Update Date | 2025-08-22 |