| NPI | 1174547988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: AZ 79754) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: AR C8388) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2026-05-21 |