| NPI | 1619460144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: KS 94-09516) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: WA MD70018004) |
| Enumeration Date | 2018-06-09 |
| Last Update Date | 2025-09-12 |