| NPI | 1205806213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: AL 14772) |
| Additional Taxonomies | 174400000X Specialist (Licence: AL 14772) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2025-01-15 |