| NPI | 1609450527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MN 82864) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: OH 57.250802) |
| Enumeration Date | 2021-05-06 |
| Last Update Date | 2026-08-11 |