| NPI | 1710989090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: WI ME43631) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: AZ 64748) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2026-01-29 |