| NPI | 1740575984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: KY 51864) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MN 55280) |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2025-06-05 |