| NPI | 1609194695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: VA 0101273467) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 279427) |
| Enumeration Date | 2010-05-14 |
| Last Update Date | 2023-05-10 |