| NPI | 1548502925 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207YX0901X Otolaryngology, Otology & Neurotology (Licence: TX S7089) | 
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: TX S7089) | 
| Enumeration Date | 2013-03-22 | 
| Last Update Date | 2022-05-25 |