| NPI | 1780657494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MA 80628) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 17270) |
| Enumeration Date | 2006-02-12 |
| Last Update Date | 2026-06-18 |