| NPI | 1396204541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MO 2025032787) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: VA 0101282673) |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2025-11-17 |