| NPI | 1508361296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA A194090) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NC 2023-01466) |
| Enumeration Date | 2018-03-26 |
| Last Update Date | 2025-03-26 |