| NPI | 1811526528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: KS 04-51363) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: MO 2500061802) |
| Enumeration Date | 2020-04-04 |
| Last Update Date | 2025-07-14 |