| NPI | 1366963340 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: VA 0101279786) | 
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: DC MD600003588) | 
| Enumeration Date | 2017-06-29 | 
| Last Update Date | 2025-05-10 |