| NPI | 1326169160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: MN 57227) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MN 107007) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2025-06-24 |