| NPI | 1447242557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WV 14043) |
| Additional Taxonomies | 174400000X Specialist (Licence: WV WV14043) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2025-05-09 |