| NPI | 1700079480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: AZ 41839) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: IA 39062) |
| Enumeration Date | 2007-08-25 |
| Last Update Date | 2026-06-24 |