| NPI | 1679033971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: VA 0101285858) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: NC 2024-01167) |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2025-08-25 |