| NPI | 1124646906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WI 87300) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: CA A186073) |
| Enumeration Date | 2020-07-08 |
| Last Update Date | 2026-07-16 |