| NPI | 1568461333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0007X Otolaryngology, Plastic Surgery within the Head & Neck (Licence: MA 73882) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MA 073882) |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2026-02-13 |