| NPI | 1063830909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NC 2025-02144) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: FL RPT52548) |
| 207Y00000X Otolaryngology (Licence: SC 95192) | |
| 207Y00000X Otolaryngology (Licence: TX BP10066742) | |
| Enumeration Date | 2014-03-28 |
| Last Update Date | 2025-07-17 |