| NPI | 1972008886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TN 75248) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NY 323226-01) |
| Enumeration Date | 2018-03-25 |
| Last Update Date | 2025-11-03 |