| NPI | 1548881295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: CA A201633) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 57.249125) |
| Enumeration Date | 2020-05-05 |
| Last Update Date | 2025-06-29 |