| NPI | 1659723567 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: UT 14195356-1205) |
| Additional Taxonomies | 207YX0901X Otolaryngology, Otology & Neurotology (Licence: UT 14195356-1205) |
| Enumeration Date | 2016-07-05 |
| Last Update Date | 2025-01-10 |