| NPI | 1497499255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: PA MT225488) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: PA XXXXXXXX) |
| Enumeration Date | 2022-04-26 |
| Last Update Date | 2023-06-10 |