| NPI | 1790149466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: VA 0101276053) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: ME 62709) |
| 208600000X Surgery (Licence: MN 62709) | |
| 207Y00000X Otolaryngology (Licence: MN 62709) | |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2026-04-08 |