| NPI | 1598764102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: LA 15440R) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MN 80003) |
| Enumeration Date | 2005-07-15 |
| Last Update Date | 2025-06-19 |