| NPI | 1386907129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: VA 0101255417) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: GU M-2145) |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2026-07-14 |