| NPI | 1366066565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: TN 74281) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TX BP10072219) |
| Enumeration Date | 2020-06-03 |
| Last Update Date | 2025-10-08 |