| NPI | 1184165805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MO 2025039094) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: HI MD-20206) |
| 207Y00000X Otolaryngology (Licence: GA 105017) | |
| Enumeration Date | 2017-03-14 |
| Last Update Date | 2026-07-16 |