| NPI | 1285785220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: FL OS13972) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: RI DO00300) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2025-10-14 |