| NPI | 1740285063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: MT 87585) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN 29420) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2025-03-05 |