| NPI | 1255907796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MO 2026025700) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: GA 12834) |
| Enumeration Date | 2021-06-03 |
| Last Update Date | 2026-06-18 |