| NPI | 1083606834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: ID 4971546) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CO 52045) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2025-04-22 |