| NPI | 1811982085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: OH 34003193) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MT 12434) |
| 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery (Licence: MN 79003) | |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2025-04-10 |