| NPI | 1124522206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TN 67622) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TX U9573) |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2025-09-09 |