| NPI | 1104073170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA MD60719422) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MN 81158) |
| Enumeration Date | 2008-08-21 |
| Last Update Date | 2026-02-15 |