| NPI | 1053817825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: ND PT24661) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OK 45380) |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2026-07-30 |