| NPI | 1447250311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: LA 11251R) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MN 1115) |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2025-03-11 |