| NPI | 1053148650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MA 3015964) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 57.257380) |
| Enumeration Date | 2024-09-17 |
| Last Update Date | 2024-09-17 |