| NPI | 1043740830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: SC 82688) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NC 202503721) |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2025-11-24 |