| NPI | 1104171503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA C201511) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NV 17925) |
| Enumeration Date | 2012-07-23 |
| Last Update Date | 2025-08-26 |