| NPI | 1447874466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WA MD61633633) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: SC LL84262) |
| Enumeration Date | 2020-06-05 |
| Last Update Date | 2025-11-19 |