| NPI | 1649433608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: ND 12499) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: UT 7643882-1205) |
| 207Y00000X Otolaryngology (Licence: MN 79716) | |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2025-04-30 |