| NPI | 1396701652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NV 8764) |
| Additional Taxonomies | 171000000X Military Health Care Provider |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2024-10-28 |