| NPI | 1366962201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MO 2022040885) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MO 2017020201) |
| 207Y00000X Otolaryngology (Licence: KY C4190) | |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2025-07-16 |