| NPI | 1205468634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA A207835) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 33801) |
| Enumeration Date | 2020-02-04 |
| Last Update Date | 2026-06-17 |