| 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 |