| NPI | 1700111382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA A117132) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 274873) |
| Enumeration Date | 2009-10-15 |
| Last Update Date | 2025-03-13 |