| NPI | 1073991352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: AL 53896) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: GA 89695) |
| 207Y00000X Otolaryngology (Licence: TX U8447) | |
| Enumeration Date | 2015-05-07 |
| Last Update Date | 2026-08-03 |