| NPI | 1659349447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YS0012X (Licence: VA 0101102580) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: VA 0101102580) |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2025-01-02 |