| NPI | 1174963532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA C205574) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA C205574) |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2026-07-22 |