| NPI | 1780674986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OH 35041973) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: KY C5077) |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2026-02-11 |