| NPI | 1598129579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: OH 35C.003984) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MI 4301504615) |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2026-06-04 |