| NPI | 1245670637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MO 2015010863) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: KS 05-51287) |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2025-07-08 |