| NPI | 1548610850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MO 2024033203) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO 2016015527) |
| Enumeration Date | 2016-06-16 |
| Last Update Date | 2025-04-22 |