| NPI | 1467043521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: AZ 78408) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: VA 0101275578) |
| Enumeration Date | 2021-02-01 |
| Last Update Date | 2026-06-24 |