| NPI | 1578144515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: ND 24395) |
| Additional Taxonomies | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: OH 58.032292) |
| Enumeration Date | 2021-04-20 |
| Last Update Date | 2026-09-08 |